clinical educator programme - sefce

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Name: (deleted) Reflective Portfolio Assignment Date: (deleted)

Clinical Educator Programme

Reflective Portfolio Assignment

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Final Word Count: 4924

Plagiarism Declaration

I declare that the following work is my own and that the work of others has been appropriately referenced.

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Contents

Introduction .............................................................................................................................................................. 3

Designing and planning learning opportunities ................................................................................................... 3

Assessing and giving feedback to students / colleagues .................................................................................... 7

My philosophy of clinical education ..................................................................................................................... 9

Respect for individual learners and diverse learning communities ........................................................ 9

Promoting participation in higher education, acknowledging diversity and promoting

equality of opportunity ............................................................................................................................... 10

Evidence-informed approaches ................................................................................................................. 10

A commitment to CPD and continuing evaluation of my practice ..................................................... 11

Practical constraints / affordances of my workplace on teaching and learning ................................. 11

Conclusion .............................................................................................................................................................. 12

References ............................................................................................................................................................... 13

Appendices .............................................................................................................................................................. 14

Figures

Figure 1. Poll Everywhere pre-teaching survey results........................................................................8

Figure 2. Poll Everywhere post-teaching survey results......................................................................9

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Introduction

I have just completed my Core Psychiatry Training, and this month have taken up a post as a Clinical Teaching Fellow.

During my career I have aspired to end up in a medical education role. This has been strongly shaped by my own

experiences as an undergraduate student and junior doctor. I have learned from notable teaching sessions and

feedback that challenged my own insights and understanding. These ultimately influenced my choice of career. As a

doctor, teacher and mentor, I want to optimise my learning experiences for students, and ensure they get the most

out of any potential learning opportunity.

With that being said, I was not entirely sure how I could accomplish these aims as I started working within clinical

practice. Prior to starting Clinical Educator Programme (CEP) I had no formal training in educational methods. As a

junior doctor I felt challenged trying to provide teaching opportunities of value whilst working in a busy and time

limited system. I was in awe at times of some of the learning opportunities I had been on the receiving end of, with

little knowledge of how the teacher had achieved this. The CEP has provided a sound framework for me to begin this

journey of understanding relatively early in my career, and a springboard for me to pursue further qualification in

medical education. I felt spurred to enter the programme after attending the South-East Faculty of Clinical Educators

(SEFCE) Symposium in 2012, with Professor Eric Mazur’s keynote presentation on the ‘flipped classroom’ a particular

highlight. Once enrolled, I attended workshops in Fife and Lothian before signing up to the Edinburgh Summer

School in Clinical Education (ESSCE) in 2014. The insights and knowledge I have gained through the programme have

been enormous. As I will show in this essay, my approach to teaching has drastically changed.

In my clinical role I am required to think critically about how a patient has presented at a particular time, with a

particular set of difficulties: “why this person, why here, why now”? Writing this essay has presented an opportunity

for me apply this lens to my own practice within clinical education, and how it has been shaped by my experiences

within the CEP. Over the past several years my main role as a clinical educator has been to provide a mixture of small

group and lecture-based teaching. I have also mentored students rotating through a particular placement, and in my

role with Edinburgh University as a Clinical Tutor Associate (CTA). Therefore, in the first section I will review my

education practice with respect to how I design and plan learning activities, and to how I assess and give feedback. In

the second part I will define my own ‘philosophy of clinical education’ and describe how it has evolved during my

time enrolled on the CEP.

Designing and planning learning opportunities

My first formal involvement with the CEP was my teaching observation (Appendix 2). This also happened to be my

first ever delivery of a lecture. This was to a group of fourth year medical students during their psychiatry rotation,

on the subject of dementia. I was initially tentative about teaching a large group, further compounded by being

observed by an experienced clinical educator. Thankfully, the advice from this session has been invaluable in both

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boosting my confidence and influencing how I have tried to develop as an educator on the CEP; it has shaped how I

approach engaging my audience within a teaching session itself.

On the whole, I received very positive and encouraging feedback during the observation, and from the students

themselves (Appendix 4a). From my psychiatry training I have always considered setting up a room and the physical

environment to be a key skill in facilitating a satisfactory consultation. I was pleased this early preparation prior to

the lecture was positively commented upon. Given my choice of medical specialty I was glad that engaging with the

audience was identified as a strong suit as well as my non-verbal communication skills. Hearing this has allowed me

to more comfortably focus on other aspects of my development as a clinical educator, and given me the impetus to

teach more! I was also pleased that the feedback regarding my slide content was generally positive – I had tried to

provide a mixture of texts, pictures and diagrams to accommodate a range of learning styles. Following my feedback,

I have thought more about planning my slides, specifically thinking about how they may look on a projector screen. I

have subsequently changed my background designs and font colour having consulted the ‘Slides Tips’ document on

the resources section of the SEFCE website (no author given for citation).

I had been studying for membership of the Royal College of Psychiatrists at this time, and purely by coincidence had

been revising Maslow’s hierarchy of needs (Maslow, 1943) at the same time as delivering this lecture. It has only

been since engaging on the CEP that I have gained an appreciation of adapting Maslow’s theory to a learning

environment (Hutchinson, 2003). I was happy to see that, unintentionally, I had been trying to adhere to Maslow’s

principles in creating an environment conducive to learning and self-actualisation.

My observation also highlighted clear suggestions for improvement which I have taken forward. A key area of

development emerged with regards to considering the ‘safety’ of the group within Maslow’s model. Whilst I had

worked hard at fostering a supportive and respectful atmosphere, the phrasing of some of my questions (e.g. “Does

everyone feel comfortable with…?”) was identified as an area for development. This may have created an

environment where students were not comfortable speaking out for fear that they may be embarrassed or feel they

should already know the answer. This is precisely the type of scenario I had wanted to avoid. Upon discussion with

my observer, we reflected on these moments as an opportunity to actively engage the students in a learning process

– either through brainstorming or small group teaching, rather than directly questioning. I had also tried to pause for

questions every 15-20 minutes, or after a ‘knowledge dense’ slide, before then returning to the same material. My

observer highlighted that 20 minutes is really the maximum amount of time that students could stay focused on one

stimulus. I certainly agree with this from my own personal experience of being in lectures, and was interested to

seek out evidence from literature. I found an excellent synopsis (Brown & Manogue, 2001) which highlighted studies

showing performance on tests of recall of knowledge over a 40 minute lecture is vastly improved by varying the

student activity at 15-20 minute intervals.

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I recall this feedback and research as a pivotal stage in my development as an educator. The idea that changing the

focus of a session with student-led self-discovery to reinforce learning was a powerful one. The benefits appeared

two-fold: engaging the students further, and allowing myself time to pause, refocus and make my teaching as

effective as possible. This has transformed my approach to planning such teaching delivery. One of the most valuable

sessions in the ESSCE was the small group teaching workshop. Here we trialled techniques including brainstorming,

buzz groups, line ups and snowballing. I have taken some of these small group teaching principles and learning

points (Appendix 1) into my small and large group teaching.

Utilising these techniques has been transformative for myself and the persons I am teaching. This is reflected in the

feedback from the teaching I delivered to Core Psychiatry Trainees on statistics. I used this session as a further

teaching observation, observed this time by a psychiatry registrar as part of my mandatory training requirements. I

was delighted at how engaged the trainees were during the buzz groups. As per my Teaching Card I aimed to time

the buzz groups at 15 minute intervals to break up my own slide delivery. The lecture came at a timely manner for

trainees about to sit their membership examinations, where statistics is heavily examined. The feedback from my

own observation (Appendix 4b) and from the trainees (Appendix 4c) was very positive indeed. The trainees not only

enjoyed the interactive components, but also felt they had achieved the curriculum-aligned learning objectives. To

me, this teaching experience strongly validated my own development as an educator through the CEP. I have also

taken my skills learned from the ESSCE into a series of small group workshops working with nursing staff on using of

Early Warning Scores charts. The feedback from these workshops (Appendix 4d) has again highlighted the learner

enjoyment from the interactive components of these workshops. I am immensely grateful to the CEP in equipping

me with the tools to deliver these kind of sessions effectively.

Another key area of feedback from my CEP observation was to consider the timing of my lecture and how I could

ensure all of the content for a topic is delivered. My lecture ran 10 minutes over time – so late I wasn’t able to

distribute all of my feedback forms for it, and made some students late for their clinical commitments. While, on

reflection, there is a lot of relevant subject material to cover within the topic of dementia (I was pleased to present

all of it within 70 minutes!), it is clear from feedback I must consider how this content could be delivered, and if I

could deliver it outwith the lecture. Could I give students information before the lecture to process and then discuss

within the session? Or highlight key topics for them to read after? I had recalled some of the principles of a ‘flipped

classroom’ from the SEFCE symposium the year before, where I heard Professor Eric Mazur’s enigmatic keynote

speech, before planning this teaching session; one can give students key content before the lecture allowing more

time in the lecture itself to focus on understanding. In honesty, I lacked the confidence in my own teaching abilities

to implement his methods before delivering my first large-group teaching session, even though I was aware that it

would help me to deliver all of the necessary learning objectives. But this has changed since the positive feedback I

have received following my observation. I also appreciate first-hand the necessity to consider this type of teaching

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model, in the face of an ever-expanding undergraduate medical curriculum, and increasing pressures to deliver more

content in less time. I have returned to Professor Mazur’s presentation at the symposium (available online, Mazur

2012), and to further literature on the notion of the flipped classroom (Prober and Heath, 2012). I am aware that

one needs to strike a fine balance in making sure students have information prior to a lecture beginning, but

ensuring they are not overloaded with content given their multiple other commitments. In order to do this I have

tried to adapt these principles into my own practice – for example in my teaching to Core Psychiatry Trainees on

statistics I have directed them to a small amount of recommended reading prior to the lecture itself, focusing more

in the session on working examples of statistics in practice, and then directing to further reading for the next part of

the course to consolidate knowledge and build towards the next lecture. Professor Mazur’s mantra of “not transfer

but assimilation of information is key” has really resonated with how I plan my teaching around learning objectives.

Finally, I was very grateful for the constructive input on how I could structure my lecture in further detail. A

consideration from my observation feedback was to clearly outline the learning objectives at the start of my

presentation. This has led me to further research and experience through the CEP to consider how to structure my

sessions more cohesively. Up to this point, my planning of large group teaching activities had loosely followed a

‘beginning, middle, end’ format, but did lack structure in areas such as identifying key learning points and

differentiating essential knowledge from points of interest. Through the ESSCE I have developed this further, trialling

out ways of planning my session ‘beginning’. Using the ‘MMUCKO’ planning template has been immensely helping at

the planning stage to try match what I am going to deliver in a teaching activity to what the student wants and needs

to gets out of it.

Thanks to the ESSCE I have also formally incorporated the ‘Must know, should know, could know’ approach into the

main body of my teaching set. This has helped me to rationalise the content I deliver to students, and also pair the

content of my teaching to different approaches to learning (Marton and Säljö, 1976). I have to acknowledge that

whilst I find psychiatry endlessly fascinating, there are those who may see their placement as a ‘means to an end’ in

terms of completing medical school or their foundation training. Applying the above template to my teaching has

allowed me to effectively ‘rein in’ my own enthusiasm whilst also delivering content matched to different learning

approaches. For example, in my teaching session delivered to Foundation Year 2 doctors on use of the Mental Health

Act (Appendix 4e), I deliver key ‘must know’ knowledge on the criterion for Emergency Detention, with interactive

case examples. They must know this in order to perform as safe junior doctors, and I have a one-slide summary of

this information for more surface learners. For those interested, I highlight areas for reading regarding the history

and evolution of the Scottish Mental Health Act, emphasising that this is interesting but not essential reading. This

allows any peaked interests to be explored and develop understanding for deep learners. I wonder if this has been of

the greatest benefit to the persons I teach. I am aware that when delivering a lecture that I am delivering one set of

content to a heterogeneous group of learners, with differing backgrounds and learning styles. I feel adapting the

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above approach, together with the other inputs described previously, has really helped me to comprehensively

address the needs of the learners I am teaching.

Assessing and giving feedback to students / colleagues

Alongside signing up to the ESSCE I made an effort to attend one of the CEP ‘Giving Effective Feedback’ sessions

several months before. This was to target an acute need I had become aware of – trying to give medical students

meaningful learning experiences whilst working on the busy ‘shop floor’ of the wards. I needed to teach quickly, but

at the same time make it high quality, and allow time for constructive ‘here and now’ feedback. I was not achieving

this. I was to learn in the workshop about Sanford’s Challenge / Support Grid (Sanford, 1966). Prior to attending the

CEP workshop related to feedback, I found it difficult to differentiate feedback that was quick from feedback that

was unchallenging or unsupportive. So, instead, I would tend to give it at the end of a clinical day – usually sometime

after the learning event and making myself (and any students) late home. I feared that any feedback I was giving ‘on

the fly’ was neither making students self-reflect on their practice, nor act on the feedback to make an appropriate

action plan.

Feedback tools I have learned from the CEP have transformed my approach to giving feedback in a timely manner. A

number of feedback models were appraised in the Giving Effective Feedback workshop, and out of curiosity I have

trialled several of them in the subsequent months (e.g. traffics lights, feedback ‘sandwich’). The model I have found

most useful however, is adopting Pendleton’s rules (Pendleton et al, 1984). I am aware that previously, when time

pressured, I would tend to offer my own impression of positives that had come from the learning event before

asking the student for his view. I had thought this would be helpful in growing their confidence – as I found students

often tend to immediately describe what they feel did not go well. Whilst this may be true, the CEP feedback module

has challenged the effectiveness of my previous practice. By immediately offering my own impressions, I was

effectively preventing the student from applying their own reflective observation powers. When considering Kolb’s

experiential learning cycle (Kolb, 1984), denying the student an opportunity to reflect on their practice may diminish

their chances of further conceptualisation or experimentation. This was a key factor for change which I had put on

my Learning Card from this workshop (Appendix 1).

Putting Pendleton’s rules into practice has allowed me to offer my own thoughts on positive behaviours and factors

for improvement, but first giving the student an opportunity to reflect on their own practice. I especially like the

collaborative feel of Pendleton’s model. It feels as if the student – with my direction – ultimately takes responsibility

for their own learning needs, and creates a plan with me to address these. It can also be given in a matter of

minutes– and so has ‘real-world’ validity in my clinical environment. One of the most effective applications of this

feedback model was during a Mock OSCE I organised for my CTA tutees two months after I attended the Giving

Effective Feedback workshop (Appendix 4f). Together with another CTA we generated eight scenarios for seven

rotating students, with 5 minute pauses between stations for feedback. Having a structured model to fall back on to

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provide ‘here and now’ feedback was invaluable. I was able to run the stations on time, whilst also feeling the

students had opportunity to reflect on their learning and identify clear plans to further improve their performance.

One of the greatest benefits I have had from the CEP has been applying the feedback principles from this workshop

into my impromptu teaching scenarios. When time permits I tend to follow the framework provided by Pendleton et

al. (1984). However, there are often times when I will only have a matter of minutes to deliver a teaching

observation and feedback session. As such, I was delighted to cover the one-minute preceptor model within the

ESSCE (Neher et al, 1992), and complete a learning card on this after this workshop (Appendix 1). In practice I have

found that it takes around three minutes to deliver. But this has allowed me to deliver effective teaching within a

busy working environment. Within this time I am able to commit a student to a process/diagnosis, explore their

rationale and alternatives and teach around any gaps. Thanks to the teaching on effective feedback, I feel much

more confident reinforcing positive behaviours and identifying areas for improvement.

One tool I have tried to develop through the CEP is using a student group’s own feedback as a measure of their

confidence following a teaching session. This has felt especially relevant in psychiatry, an area I have often found

students to be initially lacking confidence in. During the ESSCE large group teaching workshop, part of the session

was devoted to the attendees giving a series of short presentations. A wide range of technologies were used. I was

impressed with the interactive nature of ‘Poll Everywhere’ – an online audience response system which allows one

to create online polls which ‘live update’, and preserve the anonymity of the voter. I have since adopted this in large

group teaching formats with strong results. An example of this is where I used this in my preparation session for the

Psychiatry VIVA. I checked students were happy to participate in the poll at the cost of one standard network

message before starting. At the start of my teaching session I asked them to participate in a poll asking if they feel

confident about passing the Psychiatry Viva (Figure 1):

Figure 1. Poll Everywhere pre-teaching survey results

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Together with colleagues I then delivered content (planning using the Set, Body, Closure structure), with students

completing interactive vignette samples in small groups. I then used a further Poll Everywhere survey, asking the

students if they now feel more confident about achieving a pass in the exam. This had overwhelmingly positive

results (Figure 2).

Figure 2. Poll Everywhere post-teaching survey results

I have found seeing this positive feedback has tended to relax the students. The overall feedback for this session was

very positive (Appendix 4g). This allows the students to see their improved confidence, which can help foster a

positive group attitude. Those students I have spoken to since their exam have told me their own feedback

displayed this way allowed them to focus more on the core content of the exam as opposed to worrying about

whether or not they would pass it. I am pleased that through this use of technology from the ESSCE I have been able

to advance student learning beyond passing a particular exam, and towards a deeper understanding of the subject

matter.

My philosophy of clinical education

Respect for individual learners and diverse learning communities

In terms of respect for individuals and diverse groups, there are striking similarities between how I approach this

within education and how I approach this from a clinical perspective. Understanding the perspectives of others lies

at the heart of psychiatric practice. A person’s beliefs, their ethnic background, their socio-economic background and

their personal experiences all influence the “why this person, why here, why now” that I discussed in my

introduction. This is especially pertinent in nursing and medicine, where the student composition has become

increasingly diverse with respect to these factors. I believe this attitude of being respectfully curious about others

has equal parlance in clinical education. My development on the CEP has coincided with my development as a

psychiatrist. I have enjoyed adopting these principles symbiotically between my role in education and psychiatry. For

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example, my increasing experience as a psychiatry trainee has helped me to greater understand the influences of

one’s personal/social history on how one may act in a particular situation. This has been helpful when mentoring

tutees in my role as a Clinical Tutor Associate, and adapting my teaching to best match the needs of the learner.

Conversely, the principles learned on the CEP about how to best distribute information and feedback has helped me

to deliver information in challenging consultations in a structured manner. I hope to continue this positive feedback

loop throughout my postgraduate training and beyond.

Promoting participation in higher education, acknowledging diversity and promoting

equality of opportunity

I firmly believe that access to a higher education is a right for all, regardless of their background and circumstances. I

am acutely aware of this myself having only been able to attend Edinburgh University thanks to an Access Bursary.

Through such experiences I am conscious that barriers to further learning can unintentionally arise in medical

education. These include, but are not limited to, students not being able to access textbooks due to financial means

or limited library copies, or recommended online materials such as online access to BMJ modules only being

available if one has a paid subscription. I have revisited this myself following my involvement with the CEP. My first

large group lecture coincided with my teaching observation, and in my reflections following the observation

(Appendix 2) I have considered how to best develop interests or recommended reading in a subject with no financial

burden. I have subsequently recommended a number of free to access materials depending on the subject, the

interest of the learner and their learning style. These have included podcasts, Massive Online Open Courses, and

online videos such as Khan Academy and YouTube.

The tutees I have mentored as a CTA have had a diverse background and a huge range of personal responsibilities

and socioeconomic circumstances. It has been a pleasure to work collaboratively with them to further their

individual learning, and guide them at the early stages in their medical career.

Evidence-informed approaches

Again, there are strong similarities here between my approach to my clinical work and my approach to clinical

education. I would not treat a patient without an understanding of literature behind an approach. I tend to seek out

key studies and review articles in support of a particular intervention. It feels intuitive that I should do the same

when thinking of my own teaching practice. As mentioned in my introduction, I was looking for the CEP to give me

an understanding of how and why learning experiences can be positive. I am indebted to the guidance that it has

given me in seeking this out. For example, my teaching observation highlighted a learner’s difficulty in general with

focusing on one stimulus for more than 20 minutes. I enjoyed the subsequent literature search that followed, where

I found the original source materials and review articles in support of this evidence. I firmly believe in a role for

innovating styles of teaching delivery, but only continuing that method if it can be demonstrated to be of benefit. An

awareness of the pros and cons of the respective means of teaching is essential and have found review articles such

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as Sharma (2016) most helpful in informing my practice. Remembering these and adapting one’s teaching style

depending on the needs of the learner, the group, and resources available, is a must.

A commitment to CPD and continuing evaluation of my practice

I believe that continuously identifying and developing areas of one’s practice lies at the heart of medicine and

education. I am very grateful for the opportunities I have had to develop my interests as well as areas for

improvement through my specialty training and in education. I believe that good quality and frequent reflective

practice underpins one’s own continuous development. The formal training I have had on reflection during my

psychiatry training has helped me to identify challenging but achievable personal goals.

My CPD is helped by the fact that I really enjoy my job, and keeping up-to-date with best practice is enjoyable as well

as a professional responsibility. Recent personal highlights have included completion of membership exams to the

Royal College of Psychiatrists and presentation of work at national conferences. Undertaking the CEP has allowed me

to meet my own goals in delivering higher quality medical education, but also to become aware of where I need to

develop further. This was strongly influenced by my teaching observation. I have planned a lot of my development

on the CEP around the goals identified from that feedback session. I am delighted that I feel more confident now in

large group teaching, giving pertinent feedback and utilising small group teaching methods. I will continue to

evaluate my teaching practice regularly, and to identify further areas of development and innovation. I have felt

encouraged through my development on the CEP to enrol in further higher education, and have registered for

Edinburgh University’s Postgraduate Certificate in Academic Practice. I have also successfully applied to become a

Clinical Teaching Fellow in NHS Lothian. I aim to spur myself on to develop further as an educator, and continue to

reflect on my own practice to ensure I am providing the best care and teaching.

Practical constraints / affordances of my workplace on teaching and learning

We are presently faced with an interesting juxtaposition – NHS finances are becoming increasingly scrutinised at a

time where it ironically costs more to access university courses such as medicine. I have noticed this increasing

demand on clinical services myself during my 5 years working in NHS Lothian as a doctor. With increased strain on

resources comes increased demands on time management; one of the key skills I was looking for from the CEP was a

way to deliver good quality teaching and feedback in a time-focused manner. I was delighted to have attended the

workshops focused on impromptu teaching and on giving effective feedback. I believe we share a collective

responsibility for expanding the medical knowledge of our staff and students, and this shouldn’t be constrained by

the environment we work in. Rather, we need to adapt our own styles to fit the environment. It is worth

remembering that teaching and feedback is a two-way process, and I have been grateful to students on many

occasions for influencing my own reflection within clinics and ward rounds. In my new post as a teaching fellow I

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have a reversal of my teaching to clinical commitments; I am fortunate to be able to take my lessons forward from

the CEP to a post with much less clinical demand.

One of my other difficulties as a trainee has rotating frequently between new roles. Due to the nature of 4-6

monthly rotations I have often had to take feedback from particular learning opportunities into my next posts. For

example, I have not been able to give the same dementia lecture again since my teaching observation. However, I

firmly believe that the skillset I have acquired from the CEP is transferable. This is evidenced by my positive feedback

from my subsequent large group teaching sessions.

Conclusion

I believe the CEP is a truly excellent teaching programme. It has helped me immensely to address my immediate

teaching needs as a junior doctor. It has also allowed me to provide high quality teaching and feedback students can

reflect and act on, regardless of the busyness of the clinical environment. My capacity to reflect on my own teaching

style has been enhanced, and I have found my teaching to be much more adaptable depending on the need of the

learner. I look forward to opportunities to teach within different environments. I can thank the CEP to a large extent

for influencing my career and personal development. I eagerly await the challenges that lie ahead in my teaching

fellowship, and throughout my Postgraduate Certificate in Academic Practice.

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References

Brown G, Manogue M. AMEE Medical Education Guide No 22: Refreshing lecturing: a guide for lecturers. Medical

Teacher, 2001; 23(3), 231 – 44.

Hutchinson L. ABC of learning and teaching: Educational environment. BMJ 2003; 326:810–2

Kolb, DA. Experiential Learning: Experience as the Source of Learning and Development. 1984. New Jersey: Prentice-

Hall Inc.

Maslow, A.H. A theory of human motivation. Psychological Review, 1943; 50(4), 370 – 96.

Mazur, E. Confessions of a converted lecturer. Presentation delivered at SEFCE Symposium 2012. Slides available at

http://mazur.harvard.edu/search-talks.php?function=display&rowid=2026. Viewed online in September 2014, and

again in July 2016.

Marton F, Säljö R. On qualitative differences in learning. I – Outcome and Process. British Journal of Educational

Psychology, 1976; 46, pp. 4 – 11.

Neher JO, Gordon KC, Meyer B, Stevens N. A five-step “microskills” model of clinical teaching. J Am Board Fam Pract

1992; 5:419-24.

Pendleton D., Schofield T., Tate P. & Havelock P. (1984) The Consultation: an Approach to Learning and

Teaching.Oxford: Oxford University Press.

Prober C.G, Heath C. Lecture halls without lectures – a proposal for medical education. NEJM, 2012; 366: 1657 –

1659.

Sanford, N. Self and society: Social change and individual development. 1966, New York: Atherton

Sharma N. Where evidence is based medical training? BMJ Careers, 2016. Online article, available at

http://careers.bmj.com/careers/advice/Where_is_evidence_based_medical_training%3F. Read in print, accessed on

1st August 2016.

http://mazur.harvard.edu/search-talks.php?function=display&rowid=2026

http://careers.bmj.com/careers/advice/Where_is_evidence_based_medical_training%3F

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Name (deleted) Reflective Portfolio Assignment Date (deleted)

Appendices

1. Reflective learning cards

a. Small Group Teaching ................................................................................................................................15

b. Impromptu Clinical Teaching .....................................................................................................................16

c. Giving Effective Feedback...........................................................................................................................17

2. Teaching observation and feedback ........................................................................................................18

3. Teaching log .............................................................................................................................................23

4. Feedback on teaching

a. Undergraduate Year 4 Medicine: Dementia Teaching................................................................................24

b. MRCPsych Course: Statistics Course – Numerical Data: assessment of my Teaching & Feedback…………..25

c. MRCPsych Course: Statistics Course – Numerical Data: feedback from Trainees……………………………………27

d. Jardine Clinic, Royal Edinburgh Hospital: Nursing Staff Workshop on Early Warning Scores Charts……….29

e. Foundation Year 2: Teaching on the Mental Health Act…………………………………………………………………………30

f. Clinical Tutor Associate Teaching: Mock OSCE……………………………………………………………………………………….32

g. Undergraduate Yr 4 Medicine: A Guide to the Psychiatry “Orals on Clinical Issues”……………………………….33

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Appendix 1. Reflective Learning Cards

1.a. Small Group Teaching Learning Card

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1.b. Impromptu Clinical Teaching Learning Card

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1.c. Giving Effective Feedback Learning Card

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Appendix 2. Teaching observation and feedback

Trainee observed: (deleted)

Observed and feedback given by: Lisa MacInnes Fellow in Medical Education (Tutor of the Clinical Educator Programme) Centre for Medical Education (CME) College of Medicine & Veterinary Medicine The University of Edinburgh Room GU304 Chancellor's Building 49 Little France Crescent Edinburgh EH16 4SB

Details of teaching: (To be completed by consultant/trainee observed)

Date (deleted)

Location REH

Type of teaching (e.g. tutorial) Lecture

Audience (e.g.3rd year medical students) Year 4 students

Length of session 1 hr 10 mins

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ASPECT COMMENTS VOICE

(Clarity, diction, interest) UKPSF A2, V1

Varied tone appropriately. Very clear and engaging. Really easy to listen to, a really encouraging, confident, calm and positive tone.

PACE

(Too fast, too slow, timing etc.) UKPSF A2, V1

A really nice pace, you deliver information and questions / tasks a clear pace which allows your students to take on board AND think about all of the information you present. Slightly too much content for the hour lecture.

NON-VERBAL COMMUNICATION

(Eye contact, reinforcement of verbal signals, positioning etc.) UKPSF A2, V1

Excellent eye contact, appropriate supportive and encouraging language used to reinforce various points. Excellent positioning so the students could see you, good room set up. You come across as enthused by your topic which makes you really easy to listen to.

ORGANISATION AND PREPARATION

(Clear overview, focus on key ideas, logical sequence, recapping and signposting etc.) UKPSF A1, V2, A4, K1, K2, (V4)

Clear logical flow to your presentation. Excellent start putting Dementia in context. Clear sections within your session, regularly asking for questions.

USE OF VISUAL AIDS

(Organisation, clarity etc.) UKPSF K2, K4, (V3)

Really lovely slides - a good mix of text and images which addresses a variety of students learning styles and changes the stimulus of the session. Take care with coloured writing (the yellow was difficult to read) and over busy slides.

ATTITUDE

(Creates effective learning environment) UKPSF A4, V1, V2

Highly encouraging. The session was very informal yet structured and controlled and your warm encouraging attitude encouraged your students to learn and question.

INTERACTION

(Appropriate, well-planned, engaging) UKPSF A1, A2, V2, (V3)

Students engaged throughout. You helped to make the group feel at ease when asking and answering your questions and allowed them to think out loud.

STRUCTURE

(Specific-general, set – body – closure) UKPSF A1, A2, K2, V3

Excellent beginning, establishing who people were and the utility of the session for all. You could consider putting some learning objectives together on an initial slide. You allowed plenty of opportunity for questions to be asked at any point throughout the session. The students understood the structure of the session and what was expected of them. Good closure – excellent summary of key points.

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SELF-REFLECTION

CONSIDERING THE POINTS OUTLINED BELOW, IN FACILITATING THIS SESSION, WHAT ASPECTS OF

PROFESSIONAL VALUES DO YOU FEEL YOU DEMONSTRATED? PLEASE GIVE EXAMPLES.

Did your respect individual learners and diverse learning communities?

Overall I think I respected this, though received really useful feedback as to how to improve this in future teaching. I am

aware of different styles and approaches to learning, and I tried to plan my content to respect this – e.g. using a picture to

explain a certain key point, using an algorithm and mnemonic to describe a certain point. I tried to set up the teaching

room so that it was appropriately lit and that all students could see the content regardless of where they were in the room.

I was really pleased when Lisa’s feedback was so positive about my non-verbal communication. In future I will aim to make

my slides have a more appropriate background colour so it is easier to read. I was glad to hear that students had an

opportunity to ask questions whenever in the session, but I will think about how to make my session more accessible to

students whom are less lacking in confidence feel able to participate. The outline slide went down well, and some feedback

from the students mentions it is logically laid out. As well as the summary slide I will consider having a slide on ‘Learning

Objectives’ and things you ‘Must Know’ from the session. I look forward to trying to use techniques from the CEP in the

future to ‘break up’ the session and change the stimulus.

Did you promote participation in higher education and equality of opportunity for learners? I was able to do this in the session. The audience consisted of fourth year medical students. As Lisa stated in her feedback: “Great to signpost further recommended reading and guidelines / webpages.” At the end of the session I also encouraged students to speak to me either after the lecture or during their attachment if they wanted to develop their interest in psychiatry further. As someone who is always looking to recruit interested persons to psychiatry, these teaching sessions offer an excellent opportunity to showcase the interesting parts of the specialty, and to develop any fledging interest.

Did you use evidence-informed approaches and the outcomes from research, scholarship and continuing professional development?

I did for the majority of the presentation, although some slides were less scholarly (e.g. a picture round of persons who

have publicly disclosed their dementia diagnosis). My slides regarding epidemiology of dementia were informed by up-to-

date BMJ epidemiological surveys, with figures regarding national costing coming from NHS data and from this overview

article: 5. Burns A, Iliffe S. Dementia. BMJ. 2009;338:b75. Discussion regarding dementia diagnosis was sourced from the

relevant chapters in the students recommended textbook, together with information from the ICD-10. Arguably compiling

the presentation itself was an exercise in continuing professional development, as it has coincided early with my core

psychiatry training and has required a lot of research myself to gain a degree of mastery over the content.

Do you acknowledge the wider context in which higher education operates, recognising the implications for professional practice?

As a doctor currently working within old age psychiatry, this is something which I am acutely aware of. A key theme from

the department is the dissemination of knowledge regarding dementia, its management, and potentially its prevention.

There is a large appetite for information regarding dementia, amongst university students and members of the public. This

is reflected in the department of old age psychiatry actively promoting its work and giving talks and lectures in higher

educational facilities and beyond. I am aware in my professional practice that there remains a large amount of information

to discover regarding dementia, and consultations represent an opportunity to educate on what knowledge is available.

WHAT WENT WELL

Really lovely introduction and welcoming for all students – really approachable attitude, really nice to ask their names. You set your stall out really well, identifying the key objectives for the session so they knew what to expect. Such an excellent introduction, so clever to start with the epidemiology (even using a newspaper from today), it served to emphasise exactly WHY it is so important that they know about it and it’s utility to them. You ask questions well, very trusting manner and build an excellent rapport with the students which allow them to trust you and feel able to contribute, (particularly asking if it was OK to ask questions to students directly and allowing them to let you know if that was not a method they were comfortable with). Excellent to ask if there are questions at different points through the session (e.g. following your ‘busy slide’), or if there are any points folks wished to clarify. You signpost well within the session and identify aspects for further reading. You used the assessment form / reasoning questions really well, it made the students think and provided clear practical demonstration of the simple tests you can do and how that demonstrates different lobe functions etc. Students were engaged – taking notes and interested in all the information you presented – a good mix of physiology and practical clinical content. You present information in a really clear manner, really easy to listen to and understand yet not too simplistic. You had a good awareness of time keeping and awareness that students may have somewhere to be after your session. Good use of patient stories to illustrate types of Dementia (e.g. Lewy Body dementia). This really helps students to attach knowledge to actual clinical practice which helps with recall in the future. Really good overview of management – thinking further to psychosocial needs (family etc.) You had excellent content, maybe just a touch too much content for the hour – maybe there is a way to get them to cover / prepare a little bit in advance? Great to signpost further recommended reading and guidelines / webpages. Really good to have a summary and key take home messages at the end of the session.

WHAT COULD BE IMPROVED Structure / Interaction – The Surgical Sieve picture – You were 20 minutes into your presentation at this point and it would have been an excellent time to change the stimulus of the session and give them something to do. Educational theory identifies that by in terms of being able to recall information, 20 mins is really the max amount of time to stay on one particular type of stimulus(e.g. information giving). Perhaps they could have broken into pairs to brainstorm the types of dementia for example, simply for 2 minutes and then they could feedback to you and you could use more probing questions / clarifying questions to see how much they knew or understood – you could then fill in the blanks OR consider getting them to try out an assessment technique with each other. Questions – You are very kind when asking questions (e.g. asking them if they feel comfortable to answer), you also at times ask questions such as “are you all comfortable with what the brain does / areas of the brain?” Very often students may not openly admit that they don’t know or will be non-committal! You could consider rewording your questions and actually ask them to do things instead. You could again perhaps get them to brainstorm together or in small groups and would prevent you from having to give them all the information. That kind of interaction will help learning and recall. Content wise – maybe consider if there is anything they could read or prepare in advance that might add to your session. You could also get them to look at drugs etc. following the session as follow up learning.

HOW MIGHT ASPECTS OF THIS SESSION IMPACT ON YOUR CLINICAL PRACTICE?

Evidencing Professional Value 1: Respect individual learners and diverse learning communities

This focuses on the way teaching and supporting learning incorporate activities, actions and approaches which respect individual learners. It depicts the ways we communicate and

interact with individuals and different communities in the context of teaching and supporting learning. The term ‘diverse learning communities’ might include campus based

groups of students, electronic communicates, work based communities, or be defined on the basis of ethnicity, faith, social class, age etc. The practitioner needs to be able to

demonstrate that they value and can work effectively with and within these diverse communities.

The main group I tend to teach in my role are undergraduate medical students. Through my clinical work, and role as a

Clinical Tutor Associate, I am often amazed at how heterogeneous a group the undergraduate medical cohort are. There

are diverse ethnic backgrounds; mature students; undergraduates who are straight from school; and a huge range of

personal responsibilities and socioeconomic circumstances. These make for fascinating individual teaching sessions as I can

work collaboratively with a learner to help identify their learning needs and support them. This is slightly more challenging

when in large (and to a lesser extent small) group teaching sessions. Here the students may have a range of diverse

learning needs, yet every person will receive the same teaching delivery by me (i.e. it is much harder to adapt to each

individual learner). I really welcomed the feedback here as to how to change the stimulus of a teaching session, and will

work to develop this through the CEP programme to help improve my teaching within such a heterogeneous group.

“Diversity” also extends to what the learners want to achieve from my session – if the ‘community’ are undergraduate

students, their focus is often towards a combination of “how do I use this learning to be a safe junior doctor” and “how can

I use this learning to help with my pending exams / learning objectives”. Junior doctors who I have taught are perhaps

more focused on how my teaching is directly relevant to them. My feedback suggested having a set of learning objectives

for students to meet. When planning teaching sessions in the future I will reflect on the grade/stage of the learner

themselves to try and construct more aligned objectives.

Taking this forward clinically, psychiatric practice itself focuses on interactions with persons with a wide range of cognitive

capabilities and learning styles. In my clinical practice I will try and adapt the materials I signpost persons to depending on

their own learning needs (e.g. written information vs online material vs podcasts and App-based information). I will also

consider the feedback from this lecture to think about how I myself best present information (e.g. when giving information

and advice to a patient).

Evidencing Professional Value 2: Promote participation in higher education and equality of opportunity for

learners

The focus here is on providing evidence of how a commitment to participation in Higher Education and equality of opportunity for learners underpins practice related to teaching

and supporting learning. There is potential to cover a broad spectrum of activities, approaches and behaviours linked to all the Areas of Activity and Core Knowledge. Evidence

should ideally indicate wide and pervasive approaches to ensuring equality of opportunity.

In terms of promoting participation in higher education, I am not sure how this teaching session alone will change my

approach to promoting participating in higher education. This is influenced by the fact that my audience for this teaching

session were fourth year medical students – already engaged in a tertiary degree programme. This question itself has

made me think about how I could promote further study in such a student group – I have signposted students to further

learning materials, but I will also consider signposting students to relevant other areas of study in future to further develop

their learning – e.g. some university offer Massive Open Online Courses (MOOC) in dementia theory and prevention. This

observation has helped me to think about how my learning material – in this case lecture slides – are actually perceived by

an audience. I welcomed the input that my slides were diverse and covered a lot of different learners needs. I welcomed

Lisa’s feedback as to how to change the stimulus of a learning activity to keep diverse groups engaged. This is a key area

for me to develop going forward – to learn more about ways to keep students engaged, and with this have a wide

repertoire of learning techniques in my teaching session. In my clinical practice I will make sure patients have access to

appropriate information regarding their relevant presenting conditions.

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Appendix 3. Teaching log over course of CEP

Supporting learning

• 2013 – 2014, 2016 – Present: Employed as Clinical Tutor Associate through University of Edinburgh, providing mentoring and support for a group of 6 medical students entering their clinical year. Through this, providing ad-hoc teaching on topics as requested by the students, and longer-term

mentoring/career guidance.

• August 2016 – Present – Employed by NHS Lothian as Clinical Teaching Fellow, with view to implementing positive changes to undergraduate and postgraduate psychiatry curriculum.

Ad hoc teaching

• 2013 – 2016. Informal tutorials and feedback on interview skills with fourth year medical students

(now ‘New Year 5’) on psychiatry attachments

• Bedside teaching and clinical examination skills teaching given through my role as Clinical Tutor

Associate

Small Group Teaching

• May 2014 – Mock OSCE for 8 year 3 medical students (mixture of my own tutees and tutees from

another supervisor, joint session with another facilitator who is on the CEP programme)

• January 2014 – November 2014 – Series of 9 interactive workshops with nursing staff in Old Age

Psychiatry Wards at Royal Edinburgh Hospital, looking at use of Early Warning Scores Charts and

recognition / management of medically unwell patient.

• June 2016 - Use of the Mental Health Act. Delivered to FY2 doctors with attachments in Psychiatry at the Royal Edinburgh Hospital. (Ongoing delivery as part of FY2 teaching programme at Royal Edinburgh Hospital).

Large Group and regular teaching commitments

• November 2013. Dementia lecture. Delivered to fourth year (now ‘New Year 5’) medical students on Psychiatry rotation.

• September 2014 – Ongoing. Preparation for the undergraduate psychiatry Viva. Large group teaching (with small group subcomponent) delivered to fourth year (now ‘New Year 5’) medical

students.

• October 2015. Statistics – Understanding Numerical Data (next due to give September 2016)

• April 2016 – Ongoing: Benzodiazepines: Prescribing Guidance and Advice. Talk to all new Junior Doctors at Royal Edinburgh Hospital Induction

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Appendix 4. Feedback on teaching

4a. Undergraduate Year 4 Medicine: Dementia Teaching

Undergraduate Medicine MBChB, 2013 – 2014 Academic Year, Initially Delivered on 29th November 2013 (and

repeated in subsequent years). Feedback is from initial lecture.

Format: Lecture – large group teaching

Attendance: 20 approx (though feedback only filled in by 6)

Did you find this lecture useful? Very 6/6 Quite 0/6 No 0/6

How was the presentation?* Good 5/6 Quite 0/6 No 0/6

* - one student created an extra section entitled ‘excellent’ and circled this!

Comments:

Clear, concise

Very well thought out and logical presentation

Really helpful!

Good coverage of basics + neuro

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4b. MRCPsych course: Statistics Course – Numerical Data: Assessment of my Teaching & Feedback

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4c. MRCPsych course: Statistics Course – Numerical Data

Format: Lecture to Core Psychiatry 1 & 2 Trainees. Delivered on 14th October 2015

Attendance: 11

Were the objectives of the session clearly defined?

Strongly disagree (0/11) Disagree (0/11) Neutral (0/11) Agree (2/11) Strongly Agree (9/11)

Was the content relevant you?


Was the teaching session pitched at an appropriate level?


Did you enjoy the interactive components of the teaching?


Did you feel you could ask questions?


Did you achieve the learning objectives?


Two Things You Have Learnt from This Session

Where to look for further information. The extent of what I didn’t know & need to read about!

“The mean chases the tail” – love that way of remembering direction of skew

Categorical data. Numerical data

Definition and understanding of variance

Recap of averages and different types of data

Normal distribution. Variance.

Basic principles for descriptive statistics. Indication of level of knowledge required for examinations.

Standard deviation equations. Skew.

Variance simplified. “Mean lies to the extreme!”

One Thing That is Still Unclear

Standard error of the mean – I’m not sure I’ve exactly followed what that means

Negative skew data

Point estimates

Point estimates

What statistical tests will be covered in future teaching sessions.

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Any other Comments?

Dr (named deleted) was incredibly knowledgeable on the topic & was comfortable answering questions. Very well

paced presentation, engaging & highly relevant to our stage of training.

Very good presentation style. Clear and enthusiastic. I particularly liked the way Chris added in tips for how he

remembered things for the exam.

More sessions on the topic

Very clear & engaging. Targeted at right level.

Well presented. Good use of examples to clarify message.

Thanks

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4d. Jardine Clinic, Royal Edinburgh Hospital: Nursing Staff Workshop on Early Warning Scores Charts

Series of 7 x workshops, delivered throughout 2014 - 2015, with fellow facilitator also on the CEP Programme.

(For sake of brevity (there are 77 responses), feedback taken from first workshop delivered on own on 28th May 2014

Format: Small group teaching sessions

Attendance: 12

* - 1 x participant did not fill in this section of the form, hence scored out of 11

Comments:

Great session highlights areas of SWWS charts usually looked over i.e. urinary output/pain. And makes you

think of other issues that may affect scores i.e. dementia and new drugs being introduced

Good workshop, easy to follow and highlighted the importance behind the use of SEWS charts

I would like the idea of Powerpoint, however the discussion in group is really useful. In my opinion,

Powerpoint would give the image of how SEWS chart would work and the presentation might be easier to

follow

I enjoyed the interactive nature of the workshop

A little too easy due to my background at Liberton Hospital. Nonetheless, a good refresher.

Strongly

disagree

Slightly

disagree

Neutral Slightly

agree

Strongly

agree

I found the session useful 1/12 2/12 9/12

The presentation style was

clear

1/12 2/12 9/12

The session was too easy* 3/11 2/11 5/11 1/11

The session was too hard* 8/11 2/11 1/11

I would recommend this

workshop to my colleagues*

2/11 9/11

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4e. Foundation Year 2: Teaching on the Mental Health Act

Foundation Year 2 Teaching, 2015 – 2016 Academic Year, Initially Delivered on 20th June 2016

Format: Small group teaching sessions

Attendance: 7

I have found this tutorial useful:

Strongly disagree (0/7) Disagree (0/7) Unsure (0/7) Agree (2/7) Strongly Agree (5/7)

This tutorial has improved my understanding of duties and responsibilities for using the Mental Health Act / Granting

an Emergency Detention Certificate:


This tutorial has come at a timely manner in my rotation:


What will you take away from this session?

Appropriate use & indications for detention

Practical points RE: filling in forms

Key principles of Mental Health Act

Avoiding use of comment “detainable if wishes to leave”

List of things that DO NOT constitute a mental illness

Where to find EDC online

Rationale behind MHA

Principles of detention

Who to inform

Please suggest 1 thing which could be done to improve this session

Give earlier in presentation – helpful though too late!

Slightly late in rotation

Include examples / scenarios in community, as some of us work more in outpatients than in inpatients

Maybe some more case studies / examples

Have earlier in psychiatry placement

Q&A style session to test understanding at the end?

Any final comments:

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Good fluid presentation. Approachable and relaxed atmosphere. Clear points

Very engaging and helpful

Nice chill atmosphere, tips found very helpful

Very helpful

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4f. Clinical Tutor Associate Teaching: Mock OSCE

Clinical Tutor Associate Role, 2013 – 2014 Academic Year, Delivered on 4th May 2014, with fellow facilitator also

on the CEP Programme

Format: OSCE

Attendance: 7

Any comments as to how we could improve this for future years?

Ensure all students read through the case studies previous to sessions so can be convincing patients!!

Thank you!

Strongly

disagree

Slightly

disagree

Neutral Slightly

agree

Strongly

agree

Overall, I found the session useful 7/7

The introductory talk prior to the

workshops was useful

7/7

Having a 4th year student who had recently

gone through the process presenting was

useful

1/7 6/7

The history taking workshop was useful 7/7

The examination workshop was useful 7/7

I would recommend a similar workshop to

a colleague

7/7

The session improved my confidence

regarding the OSCE

1/7 6/7

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4g. Undergraduate Year 4 Medicine: A Guide to the Psychiatry “Orals on Clinical Issues”

Undergraduate Medicine MBChB, 2014 – 2015 Academic Year, Initially Delivered on 5th May 2015. Feedback is

from initial lecture.

Format: Mixture of large group teaching for content delivery, with smaller group teaching for case discussions

Attendance: 23

Poll Everywhere Results

Pre-tutorial survey – “Do you feel confident about passing the Psychiatry VIVA (AKA ‘Orals on Clinical Issues’)?”

Yes – 15/23 (65%) No – 8/23 (35%)

Post-tutorial survey – “Do you feel more confident now about passing the Psychiatry VIVA (AKA ‘Orals on Clinical

Issues’)?”

Yes – 18/18 No – 0/23 (5 x non-responses)

Please give up to 3 things you will take away from this session:

Format of how to approach cases

Useful recap of MHA

Highlighted areas I need to cover!

Use a simple structure to work through vignettes

Don’t stress too much about the tiny details

Good overview of how to deal with it

Structure of approaching the Viva

Important differentials

Assessing cognition quickly

How to approach viva scenarios systematically

Common topics to know

Not to say anything dangerous

Logical approach to answering vignettes

Important topics to know about

Key areas to discuss – e.g. risk, aspects of management

Important to use a framework

How important risk assessment is

Common case scenarios

List of things to familiarise

Better idea of format and how to answer

Increase in knowledge

Structure of my answers

What is expected of me

The main things to cover in revision

Framework for taking on viva

Be logical and have common sense

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They are here to make you pass, hopefully…

A systematic approach to any scenario

Safety paramount

Anything we could improve for next time?

Not really, good mixed format and efficient use of time

Handout?

More cases

handout

Example cases to take home?

No, it was great!

Nothing – it was great thank you!

Model cases and answers?

Shorter intro

Any final comments?

V.good – thanks

Really helpful

Thanks was really good

Thank you

Very useful tutorial – enjoyed the case scenarios

Cheers, really useful!

Excellent

V.Good thank you very much

clinical educator programme - sefce

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